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a�3-�so-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit 813 621 1357 <br /> Owner's Name FLORIDA MEDICAL CLINIC Owner's Phone Number � � � <br /> owner's,4ddress 38107 MARKET SQUARE DR., ZEPHYRHILLS, FL 33542 <br /> Fee Simple Titleholder Name Titleholder Phone Number C� � � <br /> Fee Simple Titleholder Address <br /> � ;-h t . ,; �: „ . � . ,..'�,ac..,,,. <br /> JobAddress 38107 MARKET SQUARE DR., ZEPHYRHILLS, FL 33542 �ot# �� <br /> Sub Division CITY OF ZEPHYRHILLS Parcel# <br /> a Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Burn � Hood Installation <br /> � Emergency Generator<30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale � <br /> a Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNURi � / � <br /> ry emi �n er j /j� � Q � / <br /> Sprinkler � � ❑ ❑ � � Recreational Burn 1 � <br /> � ✓.. . � <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers �� ` � <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations `� <br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofinglfar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application-ANNUAL $25.QQ Valuation of Project <br /> Fuel Tanks <br /> Q Other <br /> Contractor Company e �` �� y 14 l <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address <br /> License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee�Current Y/N <br /> Address <br /> License# <br /> OTHER �EFFERY D. BURNHAM Company RODAN FIRE SPRINKLERS, INC. <br /> Signature � Registered Y/N Fee Current Y/N <br /> Address � 7 F 1 License# � 1 <br /> Directions. ' ' <br /> Filt out application completely <br /> Owner&Contractor sign back of application,notanzed(Or,copy of signed contract with owner) <br /> If over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> Supply two(2)sets of drawings with applicable documentation <br /> Ailow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov com) <br />